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See a sample rate comparisonCPT 42400 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Saliva Gland Biopsy, A Procedure To Remove A Sample Of Tissue From A Saliva Gland For Testing (Biopsy). The Sample May Be Taken In A Surgery Or With A Needle.
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| Common Place of Service | 22 - On Campus Outpatient Hospital 11 - Office |
| Common Modifiers | LT - Left side of body RT - Right side of body |
| Complexity Level | Low |
| Medicare Fee Schedule | $94.53 national non-facility rate (2026) · View Medicare rates for 42400 |
| Medicaid Fee Schedule | $76.20 median of the 8 states in the free preview · View Medicaid rates for 42400 |
National average reimbursement for CPT 42400 by major payers:
$125.14
$137.71
$146.20
$100.15
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CPT 42400
5 of 25 sample ratesHigher to lower in this preview
Vaqar Shah
$241.95Published rateChristopher Marino
Town Center Orthopaedic Associates, P.C.
$147.20Published rateKayvan Keyhani Md PC
$96.88Published rateSangeeta Agarwal
Coastal Medical Group PA
$76.79Published rateSangeeta Agarwal
Coastal Medical Group PA
$58.87Published rate
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See a sample payer proposalCPT 42400 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 42400 code is part of the Surgery services used for Surgical Procedures on the Digestive System. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 42400 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 42400-CPT | Low | Saliva Gland Biopsy, A Procedure To Remove A Sample Of Tissue From A Saliva Gland For Testing (Biopsy). The Sample May Be Taken In A Surgery Or With A Needle. |
| 42405-CPT | Moderate | Saliva Gland Biopsy, A Procedure To Remove A Sample Of Tissue From A Saliva Gland For Testing (Biopsy). The Sample May Be Taken In A Surgery Or With A Needle. |
| 42410-CPT | Moderate | Xcision Of Parotid Tumor/Parotid Gland; Lateral Lobe W/O Nerv, Excision Of Parotid Tumor Or Parotid Gland; Lateral Lobe Without Nerv |
| 42415-CPT | High | Excision Of Parotid Tumor Or P, Excision Of Parotid Tumor Or Parotid Gland Lateral Lobewith Dissection And Preservation Of Facial Nerve |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 42400. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 42400 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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